MEDICARE: KNOTTS LANDING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326397126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOTTS LANDING

Provider Business Mailing Address
First Line	:	6606 LOCKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-4165
Country	:	US
Telephone Number	:	281-458-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	6606 LOCKWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-4165
Country	:	US
Telephone Number	:	281-458-7277
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	MRS. RONALDA MARIE STELLY
Credential	:	LVN
Telephone Number	:	281-458-7277

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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Directions to “KNOTTS LANDING ” Practice Location

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